Please tick if you have, or have had, any joint, ligament, cartilage, tendon, muscle or bone injuries relating to:

Ankle

Shoulder

Knee

Elbow

Back

Hip

Neck

Others

Details

Are you currently taking any medication?Details

Are you currently, or have you recently been pregnant?

Please tick if you're interested in:

Personal Training

Boot Camp

Group Training

Emergency Contact Details

Contact NameRelationshipPhone

I advise that I do not suffer from any medical condition that may affect my ability to
participate safely in strenuous exercise. Any relevant pre-existing medical conditions,
injuries or illnesses are detailed above. I wish to participate in the Group Boxing sessions
provided by Fitness 4 U and voluntarily assume the risk of injury to myself.

I hereby release and indemnify Fitness 4 U and its principal, Ron Daniels, its employees
and agents from all actions or claims for compensation arising from my participation,
for personal injury or damage to property.